Nutrition activation and dietary intake disparities among US adults.

OBJECTIVE
To introduce the concept 'nutrition activation' (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.

DESIGN
Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.

SETTING
USA.

SUBJECTS
Adult participants (n 7825) in the 2007-2010 National Health and Nutrition Examination Survey.

RESULTS
Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger 'spike' in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).

CONCLUSIONS
Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.